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This is VAERS ID 26803

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26803
VAERS Form:
Age:79.8
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11224 / - RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, MYALGIA, COUGH INC, HEART FAIL RIGHT, FLUTTER ATR

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 12/8/2009

VAERS ID: 26803 Before After
VAERS Form:
Age:79.8
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-12-03 1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11224 / - RA / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure, FEVER, MYALGIA, COUGH INC, HEART FAIL RIGHT, FLUTTER ATR

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 8/31/2010

VAERS ID: 26803 Before After
VAERS Form:
Age:79.8
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / - RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 7/7/2013

VAERS ID: 26803 Before After
VAERS Form:
Age:79.8
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / - RA / SC
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / - RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 2/14/2017

VAERS ID: 26803 Before After
VAERS Form:
Age:79.8 79.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / - RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 5/14/2017

VAERS ID: 26803 Before After
VAERS Form:
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / - RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 9/14/2017

VAERS ID: 26803 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / - UNK RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 2/14/2018

VAERS ID: 26803 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / UNK RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 6/14/2018

VAERS ID: 26803 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / UNK RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 8/14/2018

VAERS ID: 26803 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / UNK RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 9/14/2018

VAERS ID: 26803 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / UNK RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 10/14/2018

VAERS ID: 26803 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / UNK RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 12/24/2020

VAERS ID: 26803 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / UNK RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

Changed on 12/30/2020

VAERS ID: 26803 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / UNK RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=26803&WAYBACKHISTORY=ON


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